Deck 12: Change Agents, Quality Improvement, and the Learning Organization

Question 1

Areas in which nurses can make quality improvement efforts that have a positive impact include:

A) Direct care processes
B) Healthcare financing
C) Shifting organizational cultures from toxic to healthy
D) Teaching methods in nursing education
E) All of the above

Answer 1

All of the above

Question 2

Calling upon nurses to be positive agents of change arises from the recognition of all of the following things about nurses EXCEPT:

A) They are the largest workforce in healthcare
B) They are predominantly women
C) They have indispensable knowledge and skills
D) They are present at every interface of healthcare delivery

Answer 2

They are predominantly women

Question 3

The IOM report The Future of Nursing: Leading Change, Advancing Health contained all of the following messages about the roles nurses should play EXCEPT:

A) Be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States
B) Maintain command-and-control management over nurse assistants
C) Achieve higher levels of education
D) Practice to the full extent of their training and education

Answer 3

Maintain command-and-control management over nurse assistants

Question 4

The Transforming Care at the Bedside (TCAB) program resulted in nurses doing all of the following EXCEPT:

A) Spreading successful methods to other departments
B) Generating ideas for solutions
C) Resorting to tried-and-true methods
D) Identifying problems

Question 5

Ethical contradictions that nurses have regarding what they can share with patients regard all of the following EXCEPT:

A) Company operations
B) Unsafe medical practices
C) Names of staff members
D) Poor staffing

Question 6

The purpose behind the creation of the Quality and Safety Education for Nurses (QSEN) Institute was to:

A) Prepare future nurses to continuously improve quality and safety of healthcare systems
B) Promote relationships between nursing faculty and educators within other healthcare disciplines
C) Ensure nurses gain knowledge, skills, and attitudes that will support their role as positive change agents in their places of employment
D) Both A and C

Question 7

Quality improvement refers to any changes in the delivery of care that focus on doing a better job of:

A) Making sure care is safe, equitable, and patient-centered
B) Ensuring care is timely, efficient, and effective
C) Meeting the six aims promoted by the Institute of Medicine
D) All of the above

Question 8

All of the following about the plan-do-study-act (PDSA) model as a method of quality improvement are true EXCEPT:

A) Changes can be made on a small scale.
B) PDSA should be used primarily by nurse managers.
C) PDSA was made popular by W. Edward Demings.
D) Impact of change can be determined quickly.

Question 9

Questions that should precede the plan-do-study-act (PDSA) process include:

A) What is wrong with our current system?
B) What are we trying to accomplish?
C) How will we know if a change is an improvement?
D) Both B and

Question 10

Implementing the action plan on a pilot basis and installing an ongoing measuring/monitoring system to ensure success represents which step in the focus-analyze-develop-execute (FADE) model for quality improvement?

A) Focus
B) Analyze
C) Develop
D) Execute

Question 11

Ideas for quality improvement in healthcare that will address core problems that everyone faces include:

A) Ask for and give help.
B) Remember that patients don't want to be patients.
C) Treat patients and families as you would want to be treated.
D) Do not forget your power.
E) All of the above

Question 12

A learning organization can be described as all of the following EXCEPT:

A) An organizational culture that embraces ongoing change and improvement
B) A place where staff are engaged with the purpose of what truly works best for the safest delivery of care
C) A facility in which change and quality improvement are unrelated
D) An environment in which a deliberate commitment to learning is made

Question 13

Senge's concepts about learning organizations, continuing education, sharing ideas, and listening respectfully to others are most strongly associated with:

A) Personal mastery
B) Mental model
C) Shared vision
D) Team learning

Question 14

Changing an organizational culture from toxic to healthy:

A) May take years to accomplish
B) Involves leaving old perceptions, behaviors, and attitudes behind
C) Requires creating a safe environment for change
D) All of the above

Question 15

Leaders who are learning to share power and staff members who are learning to take on more power during a culture change must learn to deal with:

A) Dependency
B) Vulnerability
C) Technology
D) All of the above

Question 16

New nurses should expect to be treated respectfully by all seasoned nurses while also keeping in mind that many seasoned nurses may:

A) Have been treated disrespectfully
B) Have witnessed much heartache and grief
C) Try to seek validation of their own bad experiences by exposing new nurses to similar ones
D) All of the above

Question 17

Which of the following characteristics, adapted from the IOM publication Best Care and Lower Cost: The Path to Continuously Learning Healthcare in America, are necessary in order to achieve a continuously learning healthcare organization? Select all that apply.

A) Elimination of urgent care wait times
B) Patient and clinician partnerships
C) Longer clinical rotations for nursing students
D) Shorter clinical internships for medical students
E) Science and informatics
F) Incentives that are aligned with improvement goals
G) Leadership committed to a continuously learning culture

Question 18

Which of the following are necessary for creating a safe environment for effective communication and collaboration? Select all that apply.

A) Creation of a list of implicit rules desired
B) A clear and compelling vision of what the environment will look like
C) Acknowledgement of inappropriate behaviors
D) A list of explicit and consistent expectations for behavior
E) Termination of staff at the first signs of poor conduct
F) Opportunities for training and practicing communication skils
G) Ongoing enforcement of good conduct

Question 19

Nurses who practice effective communication and understand their roles as potential change agents will be better prepared for initiating, supporting, and evaluating ongoing quality improvement efforts.

Question 20

The language used in the IOM publication Best Care and Lower Cost: The Path to Continuously Learning Healthcare in America differs from Senge's five disciplines, but the implications involving effective communication, empowered change agents, and collaborative care are similar.

Question 21

A nurse who withdraws from work mentally and becomes indifferent, passive, and apathetic is, per Argyris's theory, reacting to frustrations associated with an overly controlling management.

Question 22

A nurse who resists change covertly or overtly has no power.